Is COVID-19 Severity Impacted by Bariatric Surgery in the Early Postoperative Period?

Abstract

Purpose The aim of this study was to determine the real influence of bariatric surgery on the clinical evolution of patients infected with SARS-Cov-2 in the postoperative period. Methods We conducted a retrospective analysis including two groups of patients: those who presented COVID-19 before bariatric surgery and those who presented it within 3 months of postoperative. Primary outcome was related to the severity of COVID-19, measured by the following variables: presence of symptoms, need for hospitalization, ICU admission, and invasive ventilation. Laboratory markers for inflammatory response, glycemic status, and micronutrients were analyzed as secondary outcomes. Results From the 222 individuals operated on within the study period, only 66 (29.7%) presented COVID-19, 42 (18.9%) in the preoperative period and 24 (10.8%) after the procedure. Mean age was 36.3 ± 9.5 years and mean preoperative BMI was 39.9 ± 4.2 kg/m 2 . There were no statistically significant differences between the groups regarding symptoms presentation (92.9% × 87.5%, p = 0.66), need for hospitalization (11.9% × 16.7%, p = 0.713), ICU admission (4.8% × 4.2%, p = 1.000), and invasive ventilation (2.4% × 0.0%, p = 1.000). Regarding the quantitative variables, absolute lymphocyte count was significantly lower in the group who presented COVID-19 after surgery (1822.9 ± 482.2 × 2158.6 ± 552.9, p = 0.035). Conclusion Patients who had COVID-19 before and after sleeve gastrectomy did not differ with statistical significance for the presence of symptoms, need for hospitalization, ICU admission, and invasive ventilation. Graphical abstract

Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies

“…The study characteristics are described in Table 1 . Seven studies enrolled hospitalized or non-hospitalized patients with COVID-19 infection [21] , [22] , [29] , [30] , [31] , [32] , [33] , while four studies investigated the infection rate of COVID-19 in the outpatient setting during the pandemic [20] , [23] , [34] , [35] . To reduce potential bias, five studies were conducted with the matched-cohort design in which patients in the BS group were matched with those who did not have surgical intervention for their obesity (control group) [20] , [21] , [22] , [29] , [31] .…”

“…To reduce potential bias, five studies were conducted with the matched-cohort design in which patients in the BS group were matched with those who did not have surgical intervention for their obesity (control group) [20] , [21] , [22] , [29] , [31] . The other six studies included patients with obesity as the control group without matching their baseline characteristics (e.g., age, comorbidities) [23] , [30] , [32] , [33] , [34] , [35] . For the seven studies that provided BMI in both groups, the range of BMI was 31-41 and 39-45 kg/m 2 in the BS and control groups, respectively [20] , [21] , [23] , [29] , [31] , [34] , [35] .…”

“…The other six studies included patients with obesity as the control group without matching their baseline characteristics (e.g., age, comorbidities) [23] , [30] , [32] , [33] , [34] , [35] . For the seven studies that provided BMI in both groups, the range of BMI was 31-41 and 39-45 kg/m 2 in the BS and control groups, respectively [20] , [21] , [23] , [29] , [31] , [34] , [35] .…”

“…Analysis of the six studies with available information about the interval between previous BS and patient recruitment revealed a wide variation ranging from 3 months to 8.5 years [20] , [21] , [23] , [29] , [30] , [35] . The interval was more than one year in five studies [20] , [21] , [29] , [30] , [35] , while one enrolled patients undergoing BS 3 months ago as the study group and those with obesity waiting for surgical intervention as the controls [23] . Although one study reported that participants who received BS at least two weeks before the diagnosis of COVID-19 were eligible for inclusion, the actual interval was not provided [22] .…”

“…Nevertheless, despite the relatively large sample size, the weight of pooled evidence from that meta-analysis remains limited due to the small number of studies [19] . In view of the importance of this issue, there were several recent observational studies focusing on the association between prior BS and prognostic outcomes in patients with COVID-19 [20] , [21] , [22] , [23] . To provide robust evidence for clinical practice, the current meta-analysis aimed at systematically addressing this issue by incorporating the updated data to investigate the correlation of prior BS with the risk of mortality as well as its relationship with other prognostic outcomes including the need for advanced hospital care and the risks of complications.…”